Vol 22, No 2 (2025)

BACKGROUND: Eosinophilic esophagitis is an immune-mediated disease associated with activation of T2 inflammation in esophageal tissues. Monitoring eosinophilic esophagitis activity in children requires invasive diagnostic methods using general anesthesia. The study of T2 inflammatory biomarkers is currently not a generally accepted diagnostic method but may be an informative and more accessible way to monitor eosinophilic esophagitis in children over time.

AIM: Comparative assessment of serum markers of T2 inflammation in children with eosinophilic esophagitis and other T2-associated diseases and determination of the potential of these biomarkers for monitoring the course of eosinophilic esophagitis.

MATERIALS AND METHODS: A cross-sectional, single-center comparative study included patients with eosinophilic esophagitis and other T2-associated diseases without eosinophilic esophagitis aged under 18 years. All patients underwent clinical and laboratory tests, esophagogastroduodenoscopy with morphological examination of esophageal mucosa biopsy specimens. Eosinophilic esophagitis activity was assessed using the I-SEE index. The concentrations of cytokines involved in the T2 type immune response were determined in blood serum using enzyme immunoassay.

RESULTS: The study included 80 patients: 40 patients with eosinophilic esophagitis, the comparison group included 40 children with other T2-associated diseases without eosinophilic esophagitis. Male patients were statistically significantly more common in the eosinophilic esophagitis group (p = 0.004). Immunoglobulin E- and non-immunoglobulin E-mediated food allergy were statistically significantly more common in patients with eosinophilic esophagitis (p = 0.003 and p = 0.002, respectively). The levels of interleukin 4 and 13 were statistically significantly higher in the comparison group (p <0.001). However, after dividing patients with eosinophilic esophagitis into subgroups by the degree of disease activity, in patients with low eosinophilic esophagitis activity, the level of interleukin 4, 13 and eotaxin-3 was statistically significantly lower (p <0.001). The level of eosinophil peroxidase was statistically significantly higher than in the comparison group and in patients with higher eosinophilic esophagitis activity and (p = 0.045 and p = 0.030, respectively). All patients with eosinophilic esophagitis complicated by esophageal stenosis had 15 or more points on I-SEE. The level of interleukin 33 in patients with esophageal stenosis was statistically significantly higher than in patients without stenosis (p <0.001).

CONCLUSION: Biomarkers of T2 inflammation demonstrated statistical significance in relation to the activity and severity of eosinophilic esophagitis. The obtained results highlight the high potential of using these biomarkers as a minimally invasive method for dynamic monitoring of disease activity, opening up new possibilities for a personalized approach to the treatment of eosinophilic esophagitis in children.

BACKGROUND: ASIA is an autoimmune/inflammatory syndrome induced by adjuvants. Symptoms can be diverse, and the recurrent angioedema is one of the dominant manifestations. Genetic screening is discussed as a preventive option. The following alleles of genes: HLA type II (DRB1*0301 or in combination with HLA-B*08, DRB1*01, and DRB4), as well as Arg620Trp polymorphism in the PTPN22 gene are discussed as a cause of autoimmune diseases, including ASIA syndrome.

AIM: To identify the presence of causative genetic factors in patients with ASIA syndrome by genetic screening, to identify adjuvants acting as a trigger, and to evaluate the efficacy of current therapy.

MATERIALS AND METHODS: A single center observational study of 16 patients with ASIA syndrome and 10 controls was performed. Genetic screening was performed in 14 patients from the ASIA group and 10 patients from the control group. Further inclusion of patients in the study is planned.

RESULTS: All patients with ASIA were women, potential triggers included hyaluronic acid fillers 10/16 (62.5 %), including in combination with breast silicone implants 1/16 (6.25 %), arthroplasty with shoulder joint replacement 1/16 (6.25 %), face hyaluronic acid injections 5/16 (31.25 %), and calcium hydroxyapatite 1/16 (6.25 %).

The main site of angioedema was the face 15/16 (93.75 %), also larynx (1/16 (6.25 %)), upper (2/16) and lower extremities (1/16 (6,25 %)). Other symptoms included arthralgia, myalgia, muscle weakness — 1/16 (6.25%), hypocomplementemic urticarial vasculitis, lymphocytic colitis — 1/16 (6.25 %), arthralgia combined with lymphadenopathy — 1/16 (6.25 %), chronic spontaneous and solar urticaria — 1/16 (6.25 %), fixed erythema of the shoulder skin with fever, antiphospholipid syndrome — 1/16 (6.25 %), normocomplementemic urticarial vasculitis — 1/16 (6.25 %), Still’s disease — 1/16 (6.25 %).

Autoimmune response was represented by autoantibodies in 10 (62.5 %) of 16 patients. Ten (62.5 %) patients received non-sedative antihistamines at standard and escalated doses (5 as monotherapy, 1 in combination with filler removal, 1 with hydroxychloroquine, 3 with hydroxychloroquine and omalizumab), 1 (6.25 %) received tranexamic acid, 1 (6.25 %) with danazol, 1 (6.25 %) with hydroxychloroquine, and 3 (18.75 %) patients received no therapy. A combination of two genetic factors was detected in 3 (21.4 %) patients: DRB1*0301, B1*08 (in 2 patients additionally Arg620Trp polymorphism). Isolated Arg620Trp polymorphism was detected in 6 (42.8 %) patients.

CONCLUSION: Genetic factors increasing the risk of autoimmune conditions were found in 9 out of 16 patients. No genetic abnormalities were found in the control group. More than half of the patients with ASIA syndrome had genetic factors associated with autoimmunity. Further studies are needed to create reliable diagnostic and treatment algorithms.

Every third patient who makes an appointment with a specialist (dermatologist or allergologist-immunologist) suffers from itchy dermatosis. Traditionally, in Russia this term includes such diseases as atopic dermatitis, contact dermatitis, eczema and urticaria. Pathogenesis of these diseases is based on immune-mediated skin inflammation characterized by itching of varying degrees of intensity. Itching can affect productivity, sleep quality and mood, aggravate skin diseases and lead to complications. Modern antihistamines are used to control itching as monotherapy or as an addition to topical treatment. Among non-sedating antihistamines, levocetirizine holds a special place with its favorable pharmacological profile. Rapid action and optimal duration of action in combination with low risk of drug interactions, good tolerability, absence of influence on cognitive and psychomotor functions and cardiac safety make levocetirizine the drug of first choice in treatment of skin itching in itchy dermatoses. Real practice confirms the claimed characteristics of the medicine.

Bronchial asthma remains one of the most significant respiratory diseases in the world and in Russia. The number of patients with asthma is steadily increasing, and disease control is not achieved in all patients, even with adequate pharmacotherapy.

The only currently available method for the treatment of respiratory allergy that can influence the natural course of the disease is allergen-specific immunotherapy. Studying the impact of allergen-specific immunotherapy on asthma onset and progression is critical to optimizing current treatment strategies and providing new and unique options for patients with asthma. Scientific communities are focused on promoting disease-modifying solutions based on compelling clinical evidence to rethink approaches to the treatment of respiratory diseases and improve the quality of life of people with allergies. The updated Global Initiative for Asthma 2024 guidelines emphasize the importance of allergen-specific immunotherapy, especially sublingual form, in the management of allergic asthma, noting its ability to reduce the risk of onset and progression of the disease.

The article examines the main provisions of the new expert guidelines in the field of allergen-specific immunotherapy and presents the results of the EfficAPSI study, one of the largest population-based studies demonstrating the effect of sublingual immunotherapy on the course of asthma.

Deficiency of adenosine deaminase 2 is a rare monogenic disease, inherited in an autosomal recessive manner and caused by a loss-of-function mutation in the ADA2 gene. The disease is manifested by systemic vasculitis, deficiency of bone marrow failure, and/or immunodeficiency. According to international classification of inborn errors of immunity, deficiency of adenosine deaminase 2 is considered to be an autoinflammatory syndrome. Most often, the disease debuts before the age of 18, however, debuts at an older age have been reported. Due to nonspecificity of the symptoms, the correct diagnosis can be quite late, and patients can end up consulting a number of specialists besides a pediatrician or an immunologist. A delay in diagnosis, in turn, delays the start of therapy of the underlying disease, which determines the prognosis of the disease, and affects patients’ quality of life.

In this article, we present a literature review on deficiency of adenosine deaminase 2 and a clinical case with a prevailing clinical picture of vasculitis with nervous system damage, which demonstrates the importance of timely diagnosis and the relevance of knowledge of the disease by doctors of different specialties.

Immunoglobulin E is the last of the discovered immunoglobulins and is the main mediator of allergic reactions. Its role in allergy pathogenesis led to development of the first immunobiological drug for treatment of allergic diseases — omalizumab. Omalizumab binds free immunoglobulin E, preventing its binding to high-affinity receptors, thereby blocking the cascade of allergic inflammation.

This review discusses the results of the main studies of omalizumab for treatment of severe bronchial asthma, chronic spontaneous urticaria, and other allergic diseases. The drug has been used for more than twenty years, but the research is still ongoing. Thus in 2024, omalizumab was approved for use in prevention of anaphylaxis in patients with food allergies. The drug is being studied in combination with allergen-specific immunotherapy, as well as in patients with allergic bronchopulmonary aspergillosis.